When Doctors Get Sick: Three Stories of Addiction

Different paths to the bottom and back up

While the public might expect doctors and nurses to be less vulnerable to addiction, given their knowledge of the condition and its risk factors, clinicians have roughly the same rates as everyone else, if not higher, at around 10%-15%, according to the Physician Health Program (PHP) website and the National Council of State Boards of Nursing.

Healthcare professionals are also more likely than the general public to have a prescription drug addiction, particularly to opioids.

How do professionals become addicts, and how can they be helped? MedPage Today contacted addiction specialists -- including some in recovery themselves -- for the second installment in an occasional series, "When Doctors Get Sick."

It started with a bone spur 15 years ago -- an intense stabbing pain at the back of his neck -- said Daniel Edney, MD, an internist in Vicksburg, Miss.

Over a decade passed before doctors diagnosed the cause.

First came surgery, and then prescription painkillers, but the pain did not subside.

Edney battled through each work day, before collapsing at home. He began taking more opioids. He lost 50 pounds, his energy, and all hope.

"I didn't care that I was dying. I was ready for it to be over," he said.

Then his treating physician recognized his problem: opioid induced hyperalgesia, in which the painkillers amplify pain signals instead of reducing them. Up to one-third of people with the condition also have opioid addiction, Edney said.

Edney's colleagues referred him to a physicians' health program for an evaluation. He went. "I was willing to do anything to get better," he said.

Fun at First

Another physician, Peter Grinspoon, MD, tried Vicodin for the first time during medical school in 1995.

Initially, it was just for fun, but soon he couldn't function without his pills, he said.

Grinspoon continued taking opioids throughout medical school, residency, and after he began practicing.

He never got high at work, but he took pills late at night. The next morning, he would arrive at the office "irritable, spaced-out, nauseous and shaky."

After nearly overdosing in 2004, Grinspoon asked the hospital's addiction psychiatrist to flush his pills. The psychiatrist took Grinspoon's bottle of meds, prescribed him Suboxone, and urged him to get treatment. Grinspoon ignored the recommendation.

In February 2005, Grinspoon arrived at work to find state police officers waiting for him. He had written a prescription for someone who had left the U.S. and filled it himself. A savvy pharmacist alerted the police, who were pressing charges.

Grinspoon said he felt ambushed by the police and pressured to incriminate himself. He was discharged from his job. The medical board had Grinspoon sign a voluntary agreement not to practice, which is "essentially a suspension," he said. That "suspension" was to last 3 years.

In medical school, students are taught that addiction is a disease and that people who suffer from it deserve compassion. But the medical board was "critical" and "dismissive" of his disease.

Instead of finding acceptance and openness, he said, "You're like this bad person, that needs to be punished."

Drinking to Mask Unhappiness

Another story: In the mid-1990s, an advance practice nurse in her early 20s had just begun her first job, working with severely traumatized children in a locked unit outside Boston.

She was excelling at work and even chosen as "employee of the month," but her life felt small. Old friends were partying less, settling down, and getting married.

Drinking relieved her anxieties and helped her forget the difficult things she observed at work.

She was careful. She stopped going out so she could drink more, without worrying about driving. She cut herself off early, anytime she had a morning shift.

After years of this routine, she went Christmas shopping at an upscale mall. Surrounded by stunning scenery and cheery shoppers, she bought dozens of expensive presents for friends and family, even people that she hadn't made plans to see.

And at that moment, she had an epiphany: "Everything felt ridiculous." She realized she was done pretending to be ok, to be happy. She left her gifts on a park bench.

That night, she called her doctor and asked for help.

She found a 30-day rehabilitation program with a special track for health professionals and soon after joining made a connection with the other participants. This was "reassuring and terrifying" she said, "because it's not really a club you want to belong to."

She has been sober for almost 24 years.

It's hard to hear the way some colleagues describe their patients with alcoholism, she said.

"I'm sitting right there and they don't know that they're talking about me."

But she is pushing for this to change, not by talking about her addiction but by modeling a different attitude towards these patients. She thinks every medical professional should attend at least one AA meeting to understand who these patients are and what their struggles are like.

Support Is There

"Addiction is a chronic re-occurring fatal disease that affects 10% of the population in the U.S.," said Randy Easterling, MD, medical director for the Marion Hill Chemical Dependency Unit in Vicksburg, Miss.

Having a medical degree doesn't make one immune, he told MedPage Today.

Physicians, on the whole, are perfectionists, caste-conscious, and obsessive- compulsive, Easterling said: "We have to get everything right, every time."

Physicians are less likely to seek help because they fear the judgment of their colleagues and patients, and are afraid of losing their license.

Paul Earley, MD, MD, FASAM, an addiction treatment physician in Atlanta and medical director of the Georgia Professionals Health Program, said he often learns of a problem through an office administrator, a nurse, or a spouse.

He advises anyone who suspects another clinician of an addiction problem to let that colleague know he or she is concerned and encourage the troubled colleague to get an evaluation from a physician health program -- a complete physical and psychological exam.

Earley tells the physicians he works with that their problem is a "bad news, good news story."

The bad news is that physicians can get really sick, but, he adds, "If you get healthy, not only will you be able to practice again, you're going to like to practice medicine... more than you do right now."

Earley knows. He has been sober for 32 years.

Well-designed studies have shown that physicians who undergo addiction treatment have 5-year total abstinence rates of around 80%, which is much higher than the general public, Earley explained.

The difference is likely the aggressive treatment and intensive follow-up they receive, he said. If you're a bank teller struggling to overcome an addiction, no one is checking to see that you're attend meetings and having drug screenings, Earley said.

Physicians in recovery must call or log into a website daily for 3 to 5 years to see if they need to take a drug test. Those who don't are reported to the medical board.

In some instances monitoring is a permanent requirement for practice. Others request continued monitoring themselves.

"Sometimes having that screen over their head helps them not take that drink," he said.

Grinspoon's Forced Recovery

After the police visit, the fingerprinting, and an unpleasant meeting with the medical board, Grinspoon began a 90-day "rehab" program.

He also registered with the Physician's Health Services (PHS) -- intermediaries between physicians and the medical board -- who monitored his progress. Grinspoon attended the group's physician-only meetings. He credits his mentor, the group's associate director, with his eventual success.

"It helped that he had been through it before," Grinspoon said.

He joined Alcoholics Anonymous (AA), despite visions of it as a "brain-dead" Christian cult. While some of his expectations were on target, he said, he liked the people he met.

"It was amazing how we were all united together," he said.

Grinspoon is still angry with the medical board for a response he believes was overly punitive. If people with addiction were treated "more humanely" and "nonjudgmentally," he told MedPage Today, they might reach out for help sooner.

Grinspoon said he always believed that that he could handle his problem himself, "I always thought that it was just a question of will power, and when I was just a little bit less busy, I would take care of it. Kind of like making an appointment to the dentist."

He's grateful to the pharmacist who, he said, saved his life.

In 2008, Grinspoon resumed practice.

He was anxious that he wouldn't remember how to do his own job. But he remembered his mentor's advice. "He said just keep your head up and just put one foot in front of the other, and things will start feeling natural again."

In 2013, he was hired as the associate director of Physicians Heath Services in Boston.

Today, he works in an inner-city clinic in Boston affiliated with Massachusetts General Hospital and teaches at Harvard Medical School. He recently left Physician Heath Services to work on a book about his experiences, Free Refills, A Doctor Confronts his Addiction, slated for publication in February 2016.

Diagnosis Leads to Recovery

After his evaluation, Edney joined an outpatient rehabilitation program in Las Vegas. Two weeks into treatment he woke up and didn't feel pain for the first time in 15 years. It was the best day of his life, he said.

Edney said he didn't see his problem as an addiction, because he'd been so diligent about avoiding exactly that type of problem. Knowing that addiction ran in his family, he never drank in college or in medical school.

"It wasn't about enjoying the drug. The relationship was with the pain," he said.

Today, he's replaced opioids with meditation, exercise, physical rehabilitation, and chiropractic acupuncture. He has been "pain-free and drug-free" for nearly 3 years. His medical license remains unblemished.

He attends AA several times a week and calls his sponsor daily. He also participates in a separate 12-step recovery program for doctors and nurses. Today he helps physicians with their own addiction issues.

Edney shares as much of his own story with his patients as he needs to, to show "there's no judgment."

"This is about a horrible disease, it's not about horrible people," he said.

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